I recently had a conversation with friends about the role of the placebo effect in alternative medical “therapies” such as acupuncture, Reiki and homeopathy. My friends readily acknowledged that such therapies have no basis in science, but they did believe they had a role to play in modern medicine — precisely because of the placebo effect.
After all, said my friends, if you feel better after, say, undergoing acupuncture or a Reiki session or after taking a homeopathy cold “remedy,” who cares if it’s only the placebo effect at work?
And to some extent, I agree. If you want to waste your money and time on treatments that are really nothing more than “sugar pills” and magical thinking — and you are fully aware that that’s all that they are — then sure, go ahead and do it.
But, of course, it’s not as simple as all that. For alternative therapies are not harm-free.
Some alternative medicines (yes, like conventional ones) can lead to dangerous side effects. Such therapies can also keep people from getting an accurate diagnosis and/or treatment for a medical condition that requires evidence-based care.
Avoiding hard truths
And that can be a very serious matter, as is made clear in an article on this topic that was published online last week in Wired by Alan Levinovitz, an assistant professor of philosophy and religion at James Madison University and the author of “The Gluten Lie: And Other Myths About What You Eat.”
When confronted with the possibility of a troubling diagnosis, people often prefer to avoid hard truths. [Yale University neurologist Dr. Steven] Novella tells a gut-wrenching story about one of his patients, who had ALS. After the initial diagnosis, the man left the office, unable to cope with the fact that he had an incurable degenerative disease, likely to kill him within five years. He chose to visit a naturopath instead, who had redemptive news: conventional, narrow-minded medicine had misdiagnosed him. It wasn’t ALS, the naturopath said, but rather chronic Lyme disease, which could be treated with holistic, all-natural supplements.
Nearly a year later, badly degenerated, the man was back in Novella’s office. He’d wasted countless hours and thousands of dollars on false hope. Now, he was willing to listen, but with far less time to prepare for the reality of what lay ahead, and a spirit broken by disappointment. Research suggests this is no mere anecdote. Studies out of Norway, Japan, and Korea have reported higher mortality rates and lower quality of life for cancer patients who pursue complementary and alternative medicine.
(A disturbing variation of this story occurs when Homeopaths Without Borders heads into undeveloped countries after natural disasters (such as the 2010 earthquake in Haiti) to distribute their “treatments” to unsuspecting people — ones who may then not realize they need to seek conventional treatment for their injuries or illnesses.)
An ethical dilemma
As Novella explains to Levinovitz, the recent upsurge in “integrative” medicine — the adding of alternative medicine to conventional medical practices — presents an ethical dilemma for physicians.
“We’ve decided in the medical community that it’s deceptive to prescribe placebos,” Novella says. “So why would it be OK to send someone to a homeopath who’s prescribing sugar pills?”
Another “serious downstream negative effect” of alternative treatments, he adds, is that they change the patient’s perceptions of traditional doctors.
“The patient, who is not properly interpreting the placebo effect, is going to be convinced that they feel better because the principles of acupuncture are true,” says Novella. “Therefore, when they get their cancer, maybe that’s who they’ll go to first.”
There are many reasons, of course, why alternative medicine has stubbornly persisted despite its charlatanism. Part of it has to do with marketing (alternative medicine, like conventional medicine, is a multibillion-dollar-a-year industry — often involving the same large corporations) and part with the public’s lack of scientific knowledge, including how to interpret scientific evidence.
But mainstream medicine is also to blame, as Levinovitz’s article makes clear:
Novella readily acknowledges flaws in our current healthcare system. There’s not enough government research funding, which means corporations have disproportionate influence on the development of new medications. Overtaxed doctors don’t have enough time with patients, forcing them to deliver difficult diagnoses without taking sufficient time to take to answer questions and provide comfort. Doctors, especially surgeons, often have a needlessly gruff and dismissive bedside manner. Reimbursement tends to reward procedures. The list of shortcomings he provides is endless.
But Novella says that recognizing flaws in our healthcare system doesn’t mean giving up on rigorous standards for medicine.
Novella is particularly perturbed that a degree from a naturopathic college — where there is no agreed upon standard of care — counts towards board certification in integrative medicine. As he points out, naturopaths, like the one who misdiagnosed his patient’s ALS as chronic lyme disease, embrace homeopathy, sometimes as a cure for autism. They are also open to chelation treatment and fear of vaccines. “There’s lots of changes that we need to make,” he acknowledges. “But as Paul Krugman says, when the public believes in magic, it’s springtime for the charlatans.”
You can read Levinovitz’s article on the Wired website.